Introduction
Computer use in dental practice has evolved from basic billing systems to incorporation of many aspects of the computer-based oral health record. External forces to dentistry have been driving adoption of technology and computer-based resources, such as the computing power of the desktop computer, societal acceptance of computer-based information resources, and the public implementation of "The Internet" via the World-Wide Web (WWW).
The Internet, initiated by the
government for military and research activities, made a major transition and exponential growth with
the deployment of "graphical user interface" software (GUI), i.e., browsers, to access
standard documents, hypertext markup language (HTML), in the early 1990's. Subsequently, the WWW has become a "defacto"
standard for communication in many sectors of the economy and a significant telecommunication
infrastructure for developed countries. The number of
documents posted on the WWW is estimated at doubling every 20 months and by the year 2000, more than
800 million documents will be online.1,2,3,4
The explosive growth of the number
of Internet sites, along with the volume and quality of content in the sites, have provided society
with a new level of access to efficient information storage and retrieval. This resource will have an increasing impact on
decision-making, communication and entertainment processes in the future. Computer-based information resources will make the Internet
as essential as the telephone and television. It should
be noted that all of these technologies are migrating to one integrated digital device. With the utilization of standardized Internet protocols,
platform independence (the type of computer you use) can be achieved in a cost-effective manner.5,6
The
Internet allows distribution, storage, and retrieval of the information (data) "just when you
need it." Simultaneously updated data of all
types: text, sound, graphics, animation, and video, can
now be distributed globally, independent of the type of desktop computer at the end user. The amount of information available on the Internet is
impossible to have on an individual personal computer. Another
advantage, made possible by standardized information formats used with Internet/WWW technology, is
the ability to catalog and search for information in an efficient manner. This can be accomplished using Internet "search
engines," such as Alta Vista, Excite and Yahoo. A
"search engine" provides the user the ability to query for content on the WWW by entering
keywords to locate documents. HTML documents contain "metadata" about the files. Vendors who provide search engines have developed
sophisticated catalogues of metadata and hyperlinks to the indexed sites. Dentistry will continue to evolve and increase the
utilization of digital multimedia for both the oral healthcare professionals’ own acquisition of
information, as well as its distribution to our patients and colleagues, and Internet technologies
will play a major role in this transformation.
Judging Quality
With
the use of the Internet, the end user of the accessed information must scrutinize the validity of
the data obtained more than ever. One must recognize that the WWW allows anyone to now be "publisher." Healthcare professionals should apply their understanding of
the scientific method, research design, statistical analysis, and critical thinking when analyzing
information obtained from Internet resources, just as they would scrutinize paper-based medical
literature such as journal articles and product promotions. For
biomedical information, assessing quality can first be established by determining if information is
substantiated.7 This can be determined if the information reported is either
"evidence-based," "peer reviewed," or is "reviewed with references"
included. Evidence-based information at its highest
level is a meta-analysis, an in-depth unbiased review of the current literature. At the other end of the spectrum is a single case report,
but both should be backed with references (Table 1).8
Meta-analysis involves an unbiased comprehensive review of the literature and reporting on both sides of issues if controversy exists. An excellent example of this is the Cochrane Reviews (http://www.update-software.com/ccweb/cochrane/cdsr.htm). Individuals may have to subscribe for full access, but abstracts are available.9
Table 1. Assessing Quality of Information
| One must ask, is the reported information: |
|
Reports of findings in a "randomized control" study involves one’s understanding of the scientific method. Non-randomized studies, case series, and case reports should provide the reader a background perspective. Those who believe decisions should be informed by the results of research will find the contents of The Cochrane Library helpful. It is the best single source of reliable evidence-based information about outcome effects of healthcare in the world. Content is based on the collaborative meta-analysis of multiple individual studies of similar investigations with a graphical compilation of the statistical analysis.
In a meta-analysis, studies are adjusted for uncommon variables and other bias. The common variables analyzed are enhanced by the corresponding increase in the number of subjects analyzed. Like most other libraries, The Cochrane Library’s Cochrane Systematic Reviews use a process that continuously updates the published information. Important advantages of publishing using electronic media of WWW include providing the publisher the most time and cost efficient mechanism for knowledge dissemination and the user’s instant access to the latest information.
The user of this information must determine if the source is peer reviewed or does not represent individual opinion. Many Internet sites are now indicating if material is "reviewed." References should be included to substantiate the content of the information. When accessing information via the WWW and considering quality, one must also consider the type of web-site. Sites that are a directory of WWW resources, in particular those that provide reviews, are much of the time considered more reliable or unbiased such as "Megasites," Governmental, Educational, or Organizational sites. Therefore, while there are exceptions, consideration to the type of site “.com” vs. “.org” or “.edu,” may need to be taken into account. The user must determine the intent of the content, sales and marketing of products or services, or an unbiased desire to inform the end user. Some other "Practical Guidelines" for evaluating "reliability" of information found on the WWW include: the use of domain name instead of an IP address (every computer on the Internet has a unique assigned number as one can see in the URL address window of the web-browser), the determination if that site is a institutional/corporate site as opposed to a personal web-site, and if others link to the site or document.1
Evaluation
Resources
The sites listed here were included due to their relevancy to "Dentistry" for dentists and
staff involved in oral healthcare delivery and support. By
no means is this meant to be an exhaustive list, but rather a starting place for "new
users" to gain a better understanding of the wealth of information that can be tapped with this
tool. The author does not endorse the sites or products
mentioned or opinions expressed within referenced documents, but merely provides this reference as a
matter of convenience and efficiency in starting or continuing ones cyberspace journey.
To help in the
process of evaluating Internet resources, the following sites may be beneficial in furthering ones
understanding of evaluation of Internet Information Resources (NLM):
